Trimodal Therapy
Trimodal therapy (TMT) is maximum TUBRT, systemic chemotherapy and pelvic radiation.
A 2017 study looked at 40 patients over 80 w/ MIBC treated with TMT showed 54.9% OS at 3 yrs, which is comparable with radical cystectomy. RFS 42.3% at 3 years. 77% of these 40 were treated this due to underlying comorbities and 10% was for patient preference. (1) Other studies have shown complete response rates of 70-80% with 5 year DSS of 60-70% with TMT. (3,4) A retrospective study of 342 patients who had a complete response to TMT had a recurrence rate of NMIBC of 25% at a median of 1.8yrs at a median follow up of 9 years. After recurrence occurred and BCG induction there was a 59% recurrence free and 63% progression free survival. (2)
A large retrospective study of SEER data showed patients who underwent trimodal therapy had significantly decreased overall survival (hazard ratio [HR], 1.49; 95% CI, 1.31-1.69) and cancer-specific survival (HR, 1.55; 95% CI, 1.32-1.83). Median total costs were significantly higher with trimodal therapy than with radical cystectomy at 90 days ($80 174 vs $69 181) and at 180 days ($179 891 vs $107 017). (5)
A 2017 study looked at 40 patients over 80 w/ MIBC treated with TMT showed 54.9% OS at 3 yrs, which is comparable with radical cystectomy. RFS 42.3% at 3 years. 77% of these 40 were treated this due to underlying comorbities and 10% was for patient preference. (1) Other studies have shown complete response rates of 70-80% with 5 year DSS of 60-70% with TMT. (3,4) A retrospective study of 342 patients who had a complete response to TMT had a recurrence rate of NMIBC of 25% at a median of 1.8yrs at a median follow up of 9 years. After recurrence occurred and BCG induction there was a 59% recurrence free and 63% progression free survival. (2)
A large retrospective study of SEER data showed patients who underwent trimodal therapy had significantly decreased overall survival (hazard ratio [HR], 1.49; 95% CI, 1.31-1.69) and cancer-specific survival (HR, 1.55; 95% CI, 1.32-1.83). Median total costs were significantly higher with trimodal therapy than with radical cystectomy at 90 days ($80 174 vs $69 181) and at 180 days ($179 891 vs $107 017). (5)
- McPherson, Victor A., et al. "Chemoradiotherapy in octogenarians as primary treatment for muscle-invasive bladder cancer." Canadian Urological Association Journal11.1-2 (2017): 24.
- Sanchez, Alejandro, et al. "Incidence, Clinicopathological Risk Factors, Management and Outcomes of Nonmuscle Invasive Recurrence after Complete Response to Trimodality Therapy for Muscle Invasive Bladder Cancer." The Journal of urology199.2 (2018): 407-415.
- Giacalone, Nicholas J., et al. "Long-term outcomes after bladder-preserving tri-modality therapy for patients with muscle-invasive bladder cancer: an updated analysis of the Massachusetts General Hospital experience." European urology 71.6 (2017): 952-960.
- Efstathiou, Jason A., et al. "Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience." European urology 61.4 (2012): 705-711.
- Williams, Stephen B., et al. "Comparing Survival Outcomes and Costs Associated With Radical Cystectomy and Trimodal Therapy for Older Adults With Muscle-Invasive Bladder Cancer." JAMA surgery (2018).